Medical providers

On 1 October 2023, HBF’s provider agreements changed. To learn more read below or click here

HBF Medical Gap Schedules

Medical Agreements

HBF’s medical agreements are intended to make life easier for you and your patients providing greater transparency. They apply to inpatient care provided in a licenced private hospital or day hospital facility.

The agreements allow you to choose the benefit you want for your HBF patients. HBF offers two types of agreements, Fully Covered (Full Cover or Specialist Anaesthetist) and Provider Choice.

Our Full Cover agreement provides your HBF patients with a no-gap experience for eligible private hospital services. Provider Choice gives you flexibility around the fee charged to your HBF patients on an episodic basis.

We also have Direct Billing, which allows you to receive MBS only payments quicker, reducing the paperwork for you and your patients.

Access Gap Cover

Access Gap Cover is the AHSA’s gap cover scheme that aims to minimise or eliminate out-of-pocket costs for members in-hospital specialist treatment.

As a provider, Access Gap Cover allows you the flexibility to opt-in or opt-out of the agreement on an episode by episode basis and charge a co-payment if you wish to do so.

If you choose to opt-in to the AGC agreement these are your billing options:

No gap

Where you elect to charge the patient an amount equal to the AGC fee, the patient will have no gap or out of pocket to pay.

Find the latest schedule billing information here: AGC fee schedules.

Known Gap

Where you elect to charge a co-payment, under AGC you can charge a maximum of $500, or $800 for MBS items that relate to ‘Management of Labour and Delivery’ as defined in the MBS above the AGC scheduled fee per hospital episode. This is irrespective of how many MBS item numbers are included in the treatment.

Find the latest schedule billing information here: AGC fee schedules.

If you elect to charge above the allowable AGC co-payment, the account will be paid up to the MBS fee only. For more information on AGC please refer to the billing guide and terms and conditions please visit the AHSA website or contact the AHSA directly.

For more member focused information on medical out of pockets and other hospital stay costs, visit: Understand your hospital cover

AHSA Access Gap Cover schedules

For the latest Access Gap Cover billing schedules please visit the AHSA website.

Please note that the schedules are worked out on a state by state basis so please ensure you select the correct state where the procedure will be taking place within.

Better patient experience

Access to WA’s largest member base

Claiming is made easy with payment within 21 days

Help reduce bad debts

Claim electronically via Eclipse to reduce paperwork

Email your invoices for easy billing

Terms and conditions

Providers who participate in HBF’s Medical Gap Agreements, will be required to adhere to the terms and conditions, which are subject to change from time to time.

Terms and conditions

You can now email your accounts

Simply email your account to medicalinvoices@hbf.com.au in one of the following formats: PDF, JPG, TIF, PNG, DOC, XLS, or CSV. Make sure the account is not password or print-protected. If the account is received in a different format or protected we will be unable to process it for you.

You can use Eclipse right away if you have Eclipse software installed and are registered with HBF. Simply send your claims to HBF using fund id ‘HBF’ and claim type ‘AG’ to make a claim.

The Eclipse remittance advice (ERA) will match your Eclipse claim to the deposits made into your bank account, allowing for automated reconciliation of claims submitted this way.

Express pay is easy to use, simply send all fully unpaid accounts for private hospital services provided to eligible members directly to HBF.

The account will be processed by us and forwarded to Medicare. Within approximately 21 days of receiving the claim, we will arrange for the combined HBF and Medicare benefits to be paid directly to you via Electronic Funds Transfer.

Once completed, HBF will send you a remittance statement to your registered postal address.

How to:

Apply to join the Medical Gap Agreement

To apply to join our Medical Gap Agreement, please complete the Medical Gap Application Form.

Please read the application carefully, fill out all required elements and ensure that you have read the terms and conditions. Once completed, return your signed form via email to medicalgap@hbf.com.au

On receipt of your application HBF is entitled, at its discretion to:

accept or reject your application to register under the Medical Gap Agreement. This discretion will be exercised reasonably taking into consideration any matters HBF considers relevant in the decision-making process; and
impose any reasonable conditions on registration. In the event of any such conditions, the Practitioner is required to comply with these conditions

Once processed you will be notified of the result of your application and if your application to join the Medical Gap Agreement is accepted you will receive an email outlining the specifics of your registration.

Medical Gap Application Form

HBF Medical Gap Schedules

HBF schedules may be amended from time to time to accommodate changes brought about by MBS updates and to ensure our arrangement provides the best value for both members and providers.

HBF participate with AHSA in all states except WA. If you are a registered doctor practicing outside of WA, you can find the relevant AHSA Access Gap Cover Schedule here.

Full Cover & Provider Choice Specialist anaesthetist

Download Medical Benefits Schedule 1 March 2024 (PDF) Download Medical Benefits Schedule 1 March 2024 (Excel)

Download Specialist Anaesthetists Schedule 1 March 2024 (PDF) Download Specialist Anaesthetists Schedule 1 March 2024 (Excel)

*For any earlier schedules please contact medicalgap@hbf.com.au

Common medical FAQs

You can access the agreements for any HBF member with Hospital cover (including Overseas Visitors cover) provided:

They are up to date with their premiums at the time of service/treatment.
They have served any necessary waiting periods.
The service/treatment received is covered under their policy.
They are admitted to and the service/ treatment is provided at a licensed private hospital or day hospital facility.

You can find out more information by visiting https://www.hbf.com.au/provider-gap-changes

We actively promote Full Cover providers to our members via our online search tool, HBF Provider Search. Powered by HealthShare, this tool allows members to search for Full Cover providers across Western Australia, and find more information about providers such as contact details and practice locations.

In addition, we promote Full Cover providers via HealthShare’s website and GP online referral tools.

Please note, it can take up to 30 days for us to update your listing to identify you as a Member Plus provider.

Yes, our full cover agreement does not allow for you to opt in/out on a patient by patient basis. You will be required to adhere to the agreement for all eligible members.

Eligible member means any HBF member with HBF hospital cover (including overseas visitor cover) who:

is up to date with their premiums at the time a service is provided;
has served all required waiting periods;
receives a service that is covered under their policy; and
is admitted.

To update your details on both the HBF Provider Search tool and HealthShare’s website, please contact HealthShare directly.

If you no longer wish to be promoted on HBF Provider Search, please contact HealthShare.

HBF currently participates in the AHSA (Australian Health Service Alliance) Access Gap Cover. For more information please visit the AHSA website to read more about the AGC Agreement.

You can add a new provider number by completing the provider registration form and sending it to medicalgap@hbf.com.au

If you need to cease any old provider numbers/locations, you will need to complete a change of details form, which has a section for ceasing numbers/locations.

Please make sure all forms are filled out in full and have been signed and dated by the provider.

You can change your banking or contact details by completing a change of agreement form listed above and then emailing to medicalgap@hbf.com.au

To be listed on the HBF website you will firstly need to be on our full cover or specialist anaesthetist arrangement.

Once registered as a full cover or specialist anaesthetist provider you will be automatically advertised on our medical provider search.

If you are a full cover or specialist anaesthetist and no longer wish to be listed on our website please email medicalgap@hbf.com.au and request to be removed.

You will receive confirmation once your request is actioned.

Please note: to be added or removed from the HBF website can take up to 24 hours.

Being listed on the website helps our members or their referring GPs to find your contact information easier. This ensures they can make an informed decision to choose a provider who won’t charge any out of pocket costs and is at a location that is easy for them to access.

Our medical relations team are a dedicated provider support team who are available to assist you with understanding how to bill a patient and how your agreement choice works for you and your patients.

You can reach the medical relations team by emailing your query to medicalgap@hbf.com.au or contacting us on 1300 810 475 between 8am - 4pm WST, excluding public holidays.

Contact details

Our medical relations team is here to help, we are a dedicated team specifically here to assist you with your HBF medical gap queries.

Medical relations

1300 810 475 8am-4pm AWST*
medicalgap@hbf.com.au

*Monday – Friday – Closed public holidays

General Support

1300 810 475
8am-4pm AWST*

*Monday – Friday – Closed public holidays

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